Written by Carl Jay, MD, PhD, as told by Haley Levine
When patients hear the term “inoperable lung cancer,” they often think that it means the cancer they have is incurable. But thanks to advances in treatment over the past several years, this diagnosis does not mean the death penalty. There are many treatments available to slow its spread, and sometimes put you in complete remission.
There are several reasons why a patient may develop inoperable lung cancer:
- Your cancer has spread. If you’ve had stage 3 or stage 4 lung cancer, it may have spread (metastasized) outside your lungs to your chest wall, your heart, and even other distant organs.
- You have small cell lung cancer (SCLC). It is a rarer form of lung cancer and accounts for about 14% of all cases. Usually, SCLC has spread by the time doctors find it.
- Cancer is difficult to remove. If the tumor is near a blood vessel, or close to another organ, your doctor may not want to risk it.
- You have another very serious health condition. If you already have a lung condition such as chronic obstructive pulmonary disease (COPD) or are in very poor health, your doctor may be concerned that you are not strong enough to withstand surgery.
Regardless of the cause of your lung cancer, there are safe and effective treatments for it. Here’s how to make sure you get the most out of your treatment.
Be aware of game-changing remedies
Historically, we have always treated inoperable lung cancer patients with chemotherapy and radiotherapy at the same time. This usually reduces the size of the cancer, although it may not be enough to allow the patient to make a full recovery. But over the past decade, we have developed many new, revolutionary tools for use in our arsenal. The main factor is the use of immunotherapy, which are medications that help an individual’s immune system recognize and destroy cancer cells more effectively. Some examples include:
durvalumab (Imfinzi). This is a drug that binds to a specific protein, PD-L1, and helps the immune system kill cancer cells. It is used either alone or with other medications to treat adults with small cell lung cancer and non-small cell lung cancer. A 2022 study found that the 5-year survival rate for patients with non-small cell lung cancer who received durvalumab chemotherapy was 42.9%, compared to just 33.4% of those who received chemotherapy alone.
osimertinib (Tagrisso). Another promising option is to use a type of medication known as a tyrosine kinase inhibitor (TKI) after chemotherapy and radiation. This appears to work best among patients with a certain type of lung cancer known as EGFR-positive carcinoma. EGFR is a protein found on cells that helps them grow. If you have an EGFR gene mutation, your cells can get stuck and grow too much, causing cancer. It appears to offer significant benefits for patients with late-stage EGFR-positive cancers, but research is ongoing to see if it has benefits in noninvasive, early-stage cancers as well.
If you have been told that you have inoperable lung cancer, your doctor is the best source to guide you about treatment. You may also want to ask your doctor about a clinical trial, which is a type of study that tests new treatments for lung cancer before they are available to everyone. Your doctor can tell you if there is one that might be a good fit for you.
Managing side effects
The side effects of inoperable lung cancer treatment are unique due to the double wall of chemotherapy and radiation. Lung cancer in its early stages usually involves surgery, followed by a short course of radiation that may cause minor side effects such as skin irritation. But inoperable lung cancer requires a higher dose for longer periods of time. This can cause side effects such as lung irritation – which are usually
It causes shortness of breath and/or coughing – and even irritation of the esophagus, which can make swallowing very painful. Chemotherapy can cause side effects such as fatigue, anemia, hair loss, and, most seriously, an increased risk of developing a serious infection due to low blood counts.
Due to all these unpleasant side effects, patients can be expected to have difficulty sticking to their treatment. Surprisingly, they are not. I think one reason is that patients follow a near-normal routine – radiation every Monday through Friday and chemotherapy every week. They don’t have time to think about it much. But I always assure my patients that I don’t have to be a hero. Many of our patients can be on the stoic side. Their instinct is to go with the flow and not raise issues.
If you are undergoing chemotherapy and radiation for inoperable lung cancer, it is very important to communicate with your doctor regularly. Let them know about any side effects at the first sign. If you start noticing pain when swallowing, for example, don’t wait until you can barely eat or drink anything before informing your doctor. There are medications that we can prescribe to relieve some of these symptoms to make the whole process easier. This, in turn, will make it easier for you to stick to your entire treatment plan.
We know there is hope for all patients
Inoperable cancer is not always metastatic. But sometimes, it can be. In those cases, what I always assure my patients is the increased personalization of treatment. We can now genetically analyze a person’s tumor and treat it based on its likelihood of responding to specific targeted therapy.
Patients are often thrown by the numbers, and for good reason: The current 5-year survival rate for metastatic lung cancer, for example, is only about 8%. But I remind my patients that these numbers are based on people who were diagnosed at least 5 years ago. If you’re diagnosed with metastatic, inoperable lung cancer today, you may have a better outlook thanks to improved treatments.